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I —�S— I �Y� 10: 4WAM FRU -f P. 5 <br />12. What Is the depth to groundwater? <br />Describe the source of Information; <br />M Are there any water wells M this Marcel or adjacent properties? YM I I No H <br />TYPE OF WELLS <br />DISTANCE TO TANRS) <br />Pubb Well <br />it <br />Private Well <br />ft <br />Irrigg'adon Well <br />it <br />Monitoring Well <br />ft. <br />other <br />ft <br />14. Will the tank(s) pending closure be replaced with an abovegmund or underground Storage tank(s)? YES[ I NO[ I ppt <br />is- Indicate the responsible party to be billed for additional PUS -13111) staff time expanded beyond 3 hour mialtnum permit payment <br />per tank. If the party deSipated below Is different than the permit applicant e.g. property owner, the party must acknowledge <br />this respostbillty for the billing by signature and date below. <br />Name <br />Mailing Address <br />Day Phone Number( <br />22h� <br />EH 23 046 (Revised 08/13?99) Page 6 <br />Irate <br />